Colon polyps: types, removal, and what the result means for your next colonoscopy
By Dr Wong Nan-Yaw, MBBS (NUS), FRCS (Edinburgh). Published . 6 min read.
Colon polyps are small growths on the bowel lining. Most are not cancerous, but some can turn into cancer over years, so they are removed during colonoscopy and examined in a laboratory (NIDDK, NHS). The polyp type, size and number then set your next colonoscopy, from 6 months to 10 years. Dr Wong Nan-Yaw, a colorectal surgeon, explains each result.
What are colon polyps and who gets them?
Polyps are growths on the lining of the colon or rectum. They are common: the NHS estimates that around 1 in 4 people over 50 have at least one. Most cause no symptoms and are found during colonoscopy. Larger polyps occasionally cause bleeding, mucus in the stool, a change in bowel habit, or anaemia from slow blood loss.
The exact cause is not known, but age and a family history of polyps or bowel cancer make them more likely (NHS, NIDDK). The NIDDK notes that diet, physical activity, not smoking, limiting alcohol and keeping a healthy weight may lower the chance of developing them.
What types of polyp are there?
The laboratory report names the polyp type, and the two main groups are adenomas and serrated polyps. Adenomas are described as tubular, tubulovillous or villous, and by their grade of dysplasia. Serrated polyps include hyperplastic polyps, where small ones are treated like a normal result, and sessile serrated polyps, which have their own follow-up intervals.
These terms and risk groups come from the 2020 US Multi-Society Task Force on Colorectal Cancer recommendations, which many colonoscopists use to plan follow-up.
- Tubular adenoma: one or two small ones (under 10 mm) are a low-risk finding
- Tubulovillous or villous adenoma: villous features place it in a higher-risk group
- High-grade dysplasia: more abnormal cells, also a higher-risk feature
- Hyperplastic polyp: small ones in the rectum or sigmoid colon are treated like a normal result
- Sessile serrated polyp (also called sessile serrated lesion): a serrated polyp with its own follow-up interval
How are polyps removed, and is it painful?
Most polyps are removed during the colonoscopy itself. A wire loop passed through the scope cuts or burns the polyp off at its base, a step called polypectomy, and you do not feel it (NHS). Removed polyps go to the laboratory, which checks whether removal was complete and whether there are any cancerous changes.
Rarely, a polyp is too large or there are too many to remove through the scope, and part of the bowel is removed by surgery instead (NHS). A large polyp is sometimes removed in several pieces, which affects how soon it is checked again.
Polyps can also be found by CT colonography, a scan that uses X-rays to build a picture of the bowel (NHS). A polyp seen on a scan still needs a colonoscopy to remove it.
After polyp removal, contact your doctor straight away if you develop severe tummy pain, fever, bleeding that does not stop or get better, dizziness or weakness (NIDDK).
When will I need my next colonoscopy?
The interval depends on what was found, assuming the bowel was well prepared and every polyp was fully removed. Under the 2020 US Multi-Society Task Force recommendations, a normal colonoscopy means a 10-year interval, one or two small tubular adenomas mean 7 to 10 years, and higher-risk findings shorten it to 3 years or less.
| Finding at colonoscopy | Suggested next colonoscopy |
|---|---|
| Normal colonoscopy | 10 years |
| Small hyperplastic polyps (under 10 mm) in the rectum or sigmoid colon | 10 years |
| 1 to 2 tubular adenomas under 10 mm | 7 to 10 years |
| 1 to 2 sessile serrated polyps under 10 mm | 5 to 10 years |
| 3 to 4 tubular adenomas under 10 mm | 3 to 5 years |
| Hyperplastic polyp 10 mm or larger | 3 to 5 years |
| 5 to 10 tubular adenomas under 10 mm | 3 years |
| Adenoma 10 mm or larger, villous features, or high-grade dysplasia | 3 years |
| More than 10 adenomas at one examination | 1 year |
| Adenoma 20 mm or larger removed in pieces | 6 months |
Suggested time to the next colonoscopy, by finding
- Normal colonoscopy10 years
- Small hyperplastic polyps (under 10 mm) in the rectum or sigmoid colon10 years
- 1 to 2 tubular adenomas under 10 mm7 to 10 years
- 1 to 2 sessile serrated polyps under 10 mm5 to 10 years
- 3 to 4 tubular adenomas under 10 mm3 to 5 years
- Hyperplastic polyp 10 mm or larger3 to 5 years
- 5 to 10 tubular adenomas under 10 mm3 years
- Adenoma 10 mm or larger, villous features, or high-grade dysplasia3 years
- More than 10 adenomas at one examination1 year
- Adenoma 20 mm or larger removed in pieces6 months
Source: Gupta and colleagues, US Multi-Society Task Force on Colorectal Cancer, 2020. These intervals apply to people at average risk after a complete, well-prepared examination.
The Task Force lengthened the interval for one or two small adenomas from 5 to 10 years to 7 to 10 years, because studies showed the risk of later advanced polyps in this group is similar to that after a normal colonoscopy. People given a shorter interval before 2020 may keep it, or discuss an updated plan with their doctor.
The NIDDK notes that anyone who has had polyps is more likely to develop new ones, which is why regular follow-up is advised even after every polyp has been removed.
When do these intervals not apply?
The standard intervals do not apply if you have a family history of colorectal cancer, an inherited cancer syndrome such as Lynch syndrome, inflammatory bowel disease, serrated polyposis, a past colorectal cancer, or a polyp containing cancer. The Task Force advises using the shortest suitable interval in these situations, so your colonoscopist will set a plan for you.
Intervals also depend on the quality of the examination. The Task Force intervals assume the colonoscopy reached the start of the colon, the bowel preparation was adequate, and polyps were completely removed. If that was not the case, your doctor will advise a different plan. Keep a copy of your colonoscopy and laboratory reports, because the next doctor needs both.
New symptoms, such as bleeding or a lasting change in bowel habit, should be checked when they appear rather than waiting for the planned date.
Sources
Medically reviewed by Dr Wong Nan-Yaw
MBBS (NUS), FRCS (Edinburgh). 33 years in medicine (since 1993), 23 years as an accredited specialist (since 2003) and 18 years in private practice at Mount Elizabeth (since 2008). Last reviewed 6 November 2026.
How this article is prepared
Statements are checked against the sources listed above. This article is general education and does not replace a consultation. It is reviewed and updated when guidance changes. In an emergency, call 995.